The overall objective of the proposed research is to evaluate the effects of an automated medical record chart review system (AMRCR) with regard to specfic cost items in the care of ambulatory patients with chronic diseases. The secondary objectives are to (1) identify compliance problems for which periodic computerized cost feedback is a potentially effective technique for improving compliance, especially where a relationship between process and outcome variables can be established, and (2) to assess the adaptability of the AMRCR system for the purpose of teaching quality assurance/cost awareness to undergraduate medical students and other health professionals. Patients in the study clinic with diabetes, hypertension and/or obesity have been chosen as subjects. They will be randomly assigned to two groups, with stratification according to several factors. One group will have computer chart review available to clinic physicians, the control group will not. Detailed records will be kept on all subjects throughout the study period. Study parameters will include (1) utilization of specified resources (i.e., laboratory, x-ray, clinic visits), (2) the cost of these resources in terms of dollars to the patient for a given period of time, and (3) the occurence of significant medical events. Data will be collected for 18 months and analyzed statistically. Study results will be used to assess whether the chart review system at the observed levels of physician acceptance and patient compliance (1) displays cost-regulating ability, and (2) suggests minimum cost profiles for the ambulatory care of patients with multiple chronic diseases.